Skepticism as to whether physicians or other providers should determine one’s health, along with the perception that a medicine is harmful or addictive, help to explain why patients with systemic lupus erythematosus don’t adhere to their medication regimen, a new study shows.
Researchers also found that a patient’s age, and the type and strength of medicine prescribed corresponded with greater adherence.
The study, “Medical adherence in patients with systemic lupus erythematosus in Germany: predictors and reasons for non-adherence – a cross- sectional analysis of the LuLa-cohort,” was published in the journal Lupus.
Although regularly taking prescribed medication has a major effect on the treatment of chronic disease, only about 50 percent of patients do so. Compliance can also cut healthcare costs, but there are few ways to improve it. Non-adherence can be linked to socioeconomic issues, general and personal health beliefs, and the perception of a patient’s own health.
Previous studies of factors related to adherence among systemic lupus erythematosus (SLE) patients are inconsistent. In this study, researchers set out to assess those factors among a group of patients with SLE.
They used data from the Lupus Erythematosus (LE) Long-Term Study (LuLa-study) — based on responses to an annual questionnaire given SLE patients across Germany since 2001.
Starting in 2013, questions about medical adherence, beliefs about the prescribed medication, illness perception, and the patients’ health locus of control (HLC) — whether a patient believes his or her health is determined by personal behavior — were included.
HLC comprises Internal HLC (HLCint) — when a patient considers personal behavior responsible for his or her health — and External HLC. External HLC is split into HLCdoc and HLCchance — the consideration that healthcare professionals and chance are responsible for one’s personal health.
Among the 579 patients in the LuLa study, 62.7% reported high adherence to medication. Researchers found most of the reasons for non-adherence were unintentional, such as forgetfulness or carelessness. Using statistical analysis, they discovered that the patients given the immunosuppressant medications azathioprine and prednisone (at a dose less than 7.5 mg) had higher adherence.
Older patients and those with higher HLCdoc also had a higher rate of compliance. Patients with the perception of medication as harmful or addictive had lower rates.
“A low belief that one’s own health is determined by healthcare providers (external HLC) and the belief of the harmfulness of medication were independent predictors of low adherence besides age and the choice of the medical agent,” the investigators concluded.
With regard to the emerging importance of HLCdoc, researchers emphasized that recognizing potential obstacles in physician-patient relationships is essential.
“Provision of sufficient information and education addressing these potential obstacles might help to improve adherence and reach the best possible outcome,” they stated.